EP3600322A1 - Nintedanib for use in methods for the treatment of muscular dystrophy - Google Patents
Nintedanib for use in methods for the treatment of muscular dystrophyInfo
- Publication number
- EP3600322A1 EP3600322A1 EP18715548.6A EP18715548A EP3600322A1 EP 3600322 A1 EP3600322 A1 EP 3600322A1 EP 18715548 A EP18715548 A EP 18715548A EP 3600322 A1 EP3600322 A1 EP 3600322A1
- Authority
- EP
- European Patent Office
- Prior art keywords
- muscular dystrophy
- nintedanib
- treatment
- mice
- dystrophy
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Withdrawn
Links
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Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K31/00—Medicinal preparations containing organic active ingredients
- A61K31/33—Heterocyclic compounds
- A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
- A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
- A61K31/496—Non-condensed piperazines containing further heterocyclic rings, e.g. rifampin, thiothixene or sparfloxacin
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K9/00—Medicinal preparations characterised by special physical form
- A61K9/14—Particulate form, e.g. powders, Processes for size reducing of pure drugs or the resulting products, Pure drug nanoparticles
- A61K9/141—Intimate drug-carrier mixtures characterised by the carrier, e.g. ordered mixtures, adsorbates, solid solutions, eutectica, co-dried, co-solubilised, co-kneaded, co-milled, co-ground products, co-precipitates, co-evaporates, co-extrudates, co-melts; Drug nanoparticles with adsorbed surface modifiers
- A61K9/146—Intimate drug-carrier mixtures characterised by the carrier, e.g. ordered mixtures, adsorbates, solid solutions, eutectica, co-dried, co-solubilised, co-kneaded, co-milled, co-ground products, co-precipitates, co-evaporates, co-extrudates, co-melts; Drug nanoparticles with adsorbed surface modifiers with organic macromolecular compounds
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K9/00—Medicinal preparations characterised by special physical form
- A61K9/14—Particulate form, e.g. powders, Processes for size reducing of pure drugs or the resulting products, Pure drug nanoparticles
- A61K9/16—Agglomerates; Granulates; Microbeadlets ; Microspheres; Pellets; Solid products obtained by spray drying, spray freeze drying, spray congealing,(multiple) emulsion solvent evaporation or extraction
- A61K9/1605—Excipients; Inactive ingredients
- A61K9/1629—Organic macromolecular compounds
- A61K9/1652—Polysaccharides, e.g. alginate, cellulose derivatives; Cyclodextrin
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K9/00—Medicinal preparations characterised by special physical form
- A61K9/20—Pills, tablets, discs, rods
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K9/00—Medicinal preparations characterised by special physical form
- A61K9/20—Pills, tablets, discs, rods
- A61K9/2004—Excipients; Inactive ingredients
- A61K9/2013—Organic compounds, e.g. phospholipids, fats
- A61K9/2018—Sugars, or sugar alcohols, e.g. lactose, mannitol; Derivatives thereof, e.g. polysorbates
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K9/00—Medicinal preparations characterised by special physical form
- A61K9/48—Preparations in capsules, e.g. of gelatin, of chocolate
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K9/00—Medicinal preparations characterised by special physical form
- A61K9/48—Preparations in capsules, e.g. of gelatin, of chocolate
- A61K9/4841—Filling excipients; Inactive ingredients
- A61K9/4858—Organic compounds
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
- A61P21/00—Drugs for disorders of the muscular or neuromuscular system
Definitions
- This invention relates to tyrosine kinase inhibitors, selected from nintedanib and pharmaceutically acceptable salts thereof, for use in methods for the treatment of muscular dystrophy.
- the invention relates to pharmaceutical compositions comprising said inhibitors and to methods for the treatment of muscular dystrophy with said inhibitors or compositions.
- MD Muscular dystrophy
- DMD Duchenne muscular dystrophy
- MFD X-linked recessive neuromuscular disorder, resulting eventually in premature death
- the average life expectancy for individuals afflicted with DMD is around 25 years.
- DMD is caused by a mutation in the gene coding for the protein dystrophin which is an important component within muscle tissue that provides structural stability.
- DMD DMD
- wasting muscle weakness associated with loss of muscle mass (wasting), pseudohypertrophy and low endurance.
- muscle tissue experiences wasting and is eventually replaced by fat and fibrotic tissue (fibrosis).
- fibrosis fat and fibrotic tissue
- Later symptoms may include abnormal bone development leading to skeletal deformities, including curvature of the spine (neuromuscular scoliosis), and loss of movement, eventually leading to paralysis.
- Intellectual impairment may or may not be present.
- DMD affects the pulmonary function because of respiratory muscle weakness, impaired mucociliary clearance and impaired coughing, a reduction in the compliance of the lung and the chest wall and a restriction by the scoliosis (Gozal, Pediatr Pulmonol 2000, 29, 141- 150).
- Platelet-derived growth factors constitute a family of growth factors associated with multiple cellular processes such as proliferation, chemotaxis and cell differentiation. These molecules have been related with fibrosis of several tissues in humans.
- a role of the PDGF signalling cascade in muscle fibrosis is suggested (Bonner, Growth Factor Rev 2004, 15, 255-273) by the increased PDGF-AA and -BB expression in damaged muscle fibers in vivo and in affected muscles of DMD patients.
- PDGF-AA activates fibroblast proliferation and the expression of the different components of the extracellular matrix in vitro (Bonner, Growth Factor Rev 2004, 15, 255-273).
- Increased PDGF receptor-a activation disrupts connective tissue development and drives systemic fibrosis (Olson et al., Dev Cell 2009, 16, 303-313).
- DMD DMD-derived neurotrophin coding gene
- exon skipping eteplirsen
- bypassing nonsense mutations in the dystrophin coding gene eteplirsen
- the tyrosine kinase inhibitor imatinib had shown efficacy in an animal model of DMD (Bizario et al., J Neuroimmunoi 2009, 212, 93-101 ; Huang et al., FASEB J 2009, 23, 2539-2548; Ito et al., Neuromuscular Disorders 2013, 23, 349- 56), but the results of clinical trials of imatinib in patients with fibrotic disorders (Daniels et al., Am J Respir Crit Care Mec 2010, 181, 604-610) did not warrant the continuation of the clinical program beyond phase II. Nintedanib, the compound of formula A,
- nintedanib Pharmaceutical dosage forms comprising nintedanib are disclosed in WO 2009/147212 and in WO 2009/147220.
- the use of nintedanib for the treatment of immunologic diseases or pathological conditions involving an immunologic component is described in WO 2004/017948, the use for the treatment of oncological diseases is described in WO 2004/096224 and the use for the treatment of fibrotic diseases is described in WO 2006/067165.
- Nintedanib is a highly potent, orally bioavailable inhibitor of vascular endothelial growth factor receptors (VEGFRs), platelet-derived growth factor receptors (PDGFRs) and fibroblast growth factor receptors (FGFRs). It binds competitively to the adenosine triphosphate (ATP) binding pocket of these receptors and blocks intracellular signalling.
- VEGFRs vascular endothelial growth factor receptors
- PDGFRs platelet-derived growth factor receptors
- FGFRs fibroblast growth factor receptors
- nintedanib inhibits Fms-like tyrosine-protein kinase 3 (Fit 3), lymphocyte-specific tyrosine- protein kinase (Lck), tyrosine-protein kinase lyn (Lyn) and proto-oncogene tyrosine-protein kinase src (Src) (Hilberg et al., Cancer Res. 2008, 68, 4774-4782).
- Fms-like tyrosine-protein kinase 3 Fit 3
- Lck lymphocyte-specific tyrosine- protein kinase
- Lyn tyrosine-protein kinase lyn
- Prc proto-oncogene tyrosine-protein kinase src
- the present invention relates to a tyrosine kinase inhibitor, selected from nintedanib and pharmaceutically acceptable salts thereof, for use in a method for the treatment of muscular dystrophy.
- the present invention relates to a pharmaceutical composition
- a pharmaceutical composition comprising one or more of said inhibitors and one or more pharmaceutically acceptable excipients for use in a method for the treatment of muscular dystrophy.
- the present invention relates to a method for the treatment of muscular dystrophy in a patient in need thereof, the method being characterized in that one or more of said inhibitors is administered to the patient.
- the present invention relates to the use of one or more of said inhibitors in the manufacture of a medicament for the treatment of muscular dystrophy in a patient in need thereof.
- FIG 1 is a diagrammatic representation of FIG 1 :
- CMAP compound muscle action potential
- FIG 2 is a diagrammatic representation of FIG 2
- FIG 3 is a diagrammatic representation of FIG 3
- FIG 4 is a diagrammatic representation of FIG 4
- FIG 5 is a diagrammatic representation of FIG 5
- FIG 6 is a diagrammatic representation of FIG 6
- phrases "pharmaceutically acceptable” is employed herein to refer to those compounds, materials, compositions, and/or dosage forms which are, within the scope of sound medical judgment, suitable for use in contact with the tissues of human beings and animals without excessive toxicity, irritation, allergic response, or other problem or complication, and commensurate with a reasonable benefit/risk ratio.
- pharmaceutically acceptable salt refers to derivatives of the disclosed compounds wherein the parent compound is modified by making acid or base salts thereof.
- pharmaceutically acceptable salts include, but are not limited to, mineral or organic acid salts of basic residues such as amines; alkali or organic salts of acidic residues such as carboxylic acids; and the like.
- treatment and “treating” as used herein embrace both therapeutic, i.e. curative and/or palliative, and preventive, i.e. prophylactic, treatment.
- Therapeutic treatment refers to the treatment of patients having already developed one or more of said conditions in manifest, acute or chronic form.
- Therapeutic treatment may be symptomatic treatment in order to relieve the symptoms of the specific indication or causal treatment in order to reverse or partially reverse the conditions of the indication or to stop or slow down progression of the disease.
- Preventive treatment refers to the treatment of patients at risk of developing one or more of said conditions, prior to the clinical onset of the disease in order to reduce said risk.
- treatment and “treating” include the administration of one or more active compounds in order to prevent or delay the onset of the symptoms or complications and to prevent or delay the development of the disease, condition or disorder and/or in order to eliminate or control the disease, condition or disorder as well as to alleviate the symptoms or complications associated with the disease, condition or disorder.
- therapeutically effective amount means an amount of a compound of the present invention that (i) treats or prevents the particular disease or condition, (ii) attenuates, ameliorates, or eliminates one or more symptoms of the particular disease or condition, or (iii) prevents or delays the onset of one or more symptoms of the particular disease or condition described herein.
- the present invention allows for an efficient treatment of patients with muscular dystrophy (MD) with manageable systemic side effects by administration of tyrosine kinase inhibitors, selected from nintedanib and pharmaceutically acceptable salts thereof.
- MD muscular dystrophy
- tyrosine kinase inhibitors selected from nintedanib and pharmaceutically acceptable salts thereof.
- nintedanib is efficacious in an animal model of Duchenne muscular dystrophy (DMD).
- the mdx mouse is a well characterized and widely used animal model for drug tests for DMD (Bulfield et al., Proc Natl Acad Sci USA 1984, 81, 1189-92). Mdx mice spontaneously develop a pathology resembling aspects of the human disease. They present cycles of degeneration and regeneration in the limb muscles and a progressive degeneration and fibrosis in the diaphragm (Coirault et al., J AppI Physiol 2003, 94, 1744-50). The first wave of degeneration peaks in the fourth week of life.
- muscular lesions can be observed, including myofiber necrosis, leaking myofibers as a consequence of injuries to the sarcolemma, high levels of serum creatine kinase, and the presence of large areas of inflammation, connective tissue, and fat (Collins and Morgan, Int J Exp Pathol 2003, 84, 165-72; Grounds et al., Neurobiol Dis 2008, 31, 1-19).
- Compulsory physical activity can be applied to exacerbate the muscular degeneration during this phase (De Luca et al., Am J Pathol 2005, 166, 477-89; Grounds et al., Neurobiol Dis 2008, 31, 1-19).
- the treatment of the mdx mice with nintedanib started at an age of 10 months in the 1 st study and at 6 weeks in a 2 nd study. Treatment duration was 4 weeks in the 1 st study and 7 weeks in the 2 nd study. Nintedanib was used at a dose of 60 mg/kg once daily administered intragastrically via gavage in both studies.
- the diaphragm from non-treated mdx mice had increased fibrotic tissue areas, compared to WT mice, and inflammatory infiltrates.
- the diaphragm from nintedanib-treated mdx mice had also dystrophic features, but the fibrotic area was clearly reduced and inflammatory infiltrates were not observed.
- the fibrotic area of the muscles was assessed using immunofluorescent staining for collagen VI (Col VI). 8 photographs from different muscle sections of the quadriceps, tibialis anterior and diaphragm were randomly taken. The fluorescent area was analyzed using the software package Image J. The mean fibrotic area stained for Col VI on the diaphragma in non-treated 10 months old mdx mice was of 57.8 % while it was reduced to 50.8% in nintedanib- treated animals. The reduction of 7 % by nintedanib treatment was statistically significant (p ⁇ 0.001) (FIG 3A).
- a tyrosine kinase inhibitor selected from nintedanib and pharmaceutically acceptable salts thereof, preferably nintedanib in the form of its monoethanesulfonate salt, is provided for use in a method for the treatment of MD.
- said inhibitor is preferably provided for use in a method for the treatment of MD, selected from Duchenne MD, Becker MD, myotonic dystrophy, facioscapulohumeral MD, limb-girdle MD, Emery- Dreifuss MD, congenital MD, oculopharyngeal MD, sarcoglycanopathies and dysferlinopathies like Miyoshi myopathy, most preferably for the treatment of Duchenne MD.
- MD selected from Duchenne MD, Becker MD, myotonic dystrophy, facioscapulohumeral MD, limb-girdle MD, Emery- Dreifuss MD, congenital MD, oculopharyngeal MD, sarcoglycanopathies and dysferlinopathies like Miyoshi myopathy
- compositions of the above-mentioned inhibitors may be formulated that are suitable for the administration of therapeutically effective amounts of said inhibitors for the treatment of muscular dystrophies.
- Suitable preparations for administering the active pharmaceutical ingredients of the present invention will be apparent to those with ordinary skill in the art and include for example tablets, pills, capsules, suppositories, lozenges, troches, solutions, syrups, elixirs, sachets, injectables, inhalatives and powders etc..
- Suitable tablets may be obtained, for example, by mixing one or more of the above-mentioned active pharmaceutical ingredients with known excipients, for example inert diluents, carriers, disintegrants, adjuvants, surfactants, binders and/or lubricants.
- therapeutically effective doses of nintedanib when applied orally to a patient in need thereof, may be in the range from 50 mg to 300 mg per day, preferably twice daily application of 25 mg, 50 mg, 100 mg or 150 mg, approximately 12 hours apart.
- the actual therapeutically effective amount or therapeutic dosage will of course depend on factors known by those skilled in the art such as age and weight of the patient, route of administration and severity of disease.
- the active compound will be administered at dosages and in a manner which allows a therapeutically effective amount to be delivered based upon a patient's unique condition.
- the determination of the necessity of dose adjustments, e.g. due to adverse reactions to the active pharmaceutical ingredient, and their putting into practice will be known to the one skilled in the art.
- a pharmaceutical composition comprising one or more tyrosine kinase inhibitors, selected from nintedanib and pharmaceutically acceptable salts thereof, preferably nintedanib in the form of its monoethanesulfonate salt, and one or more pharmaceutically acceptable excipients for use in a method for the treatment of MD.
- tyrosine kinase inhibitors selected from nintedanib and pharmaceutically acceptable salts thereof, preferably nintedanib in the form of its monoethanesulfonate salt, and one or more pharmaceutically acceptable excipients for use in a method for the treatment of MD.
- the pharmaceutical composition is selected from compositions for oral administration, preferably from capsules and tablets, most preferably from capsules.
- the pharmaceutical composition is preferably provided for use in a method for the treatment of MD, selected from Duchenne MD, Becker MD, myotonic dystrophy, facioscapulohumeral MD, limb-girdle MD, Emery-Dreifuss MD, congenital MD, oculopharyngeal MD, sarcoglycanopathies and dysferlinopathies like Miyoshi myopathy, most preferably for the treatment of Duchenne MD.
- the present invention relates to a method for the treatment of muscular dystrophy in a patient in need thereof with one or more of the above-mentioned inhibitors. Furthermore, the present invention relates to a method for the treatment of muscular dystrophy with one or more of the above-mentioned pharmaceutical compositions.
- the present invention relates to the use of the above-mentioned inhibitor in the manufacture of a medicament for the above-mentioned method for the treatment of muscular dystrophy.
- the hanging wire test is performed following the standard operating procedure DMD_M.2.1.004 (revised version of 29-Jun-2016) issued by the TREAT-NMD network:
- the hanging wire tests can be used to assess global "subacute" muscle function and coordination over time in young and old mdx mice.
- the test is based on the latency of a mouse to fall off a metal wire upon exhaustion. With the use of several described experimental designs, the natural course of the disease or the efficacy of genetic or pharmacologic treatment strategies can be assessed. Despite mdx mice having a less severe phenotype than DMD patients, differences in hanging performance between wild type (C57BL/10ScSnJ) and dystrophic (mdx or mdx5Cv) mice can be seen and experimental interventions can improve hanging performances.
- C57BL/10ScSnJ wild type mice
- mdx or mdx5Cv dystrophic mice
- a 55 cm wide 2-mm thick metallic wire (can be either a plain wire or a multistranded twisted wire, possibly plastic- coated) is secured to two vertical stands.
- the wire must be tightly attached to the frame to avoid vibration or unwanted displacement of the wire while the investigator is handling the animals or during the measurements, since these unwanted effects would interfere with the animal's performance.
- the wire is maintained 35 cm above a layer of bedding material to prevent injury to the animal when it falls down.
- Animals Mice as young as four weeks, and as old as approximately 19 months of age have been reliably evaluated with this test, but the test might also be applicable for older mice. Mice younger than four weeks of age may be too excitable to provide reliable values.
- mice In order to limit the stress to the animals, it is preferable that the mice have been regularly manipulated by the investigator who will perform the test. However, no acclimatization to this test is needed. Since the test implies behavioral response, different strains may not respond equally (e.g. sv129 differ from C57BL/1 OScSnJ), making the use of wild type mice of corresponding backgrounds important.
- mice are subjected to a 180 sec lasting hanging test, during which a "falling" and “reaching” score is recorded.
- a mouse falls or reaches one of the sides of the wire, the "falling" score or “reaching” score are diminished or increased by 1 , respectively.
- a Kaplan-Meier-like curve can be created afterwards.
- a 55 cm long wire can be used described in the material section. It is of great importance for the outcome of this method that the length of the wire is remained constant between different labs, since this influences the reaches outcome.
- Timer is set to 180 sec.
- the "falling” score is set to 10
- the "reaching” score is set to 0.
- a mouse is handled by the tail and brought near the wire. The operator lets it suspend by the fore limbs only. As soon as the animal is properly suspended, the timer is started. After being released, most animals catch the wire with the four limbs. This is allowed.
- step 7 If the timer reaches 0 sec, go to step 7.
- step 6 If the animal reaches one end of the wire, timer is stopped and "reaching" score is increased by 1. Then, go to step 6.
- Test is finished. Reaching and falling scores are recorded as well as the elapsed times between falls.
- a simpler protocol consists of measuring the longest suspension time in three trials. With this method an unlimited hanging time can be used or one with a fixed limit. When a fixed limit is used a hanging time of i.e. 180 or 600 seconds is recommended for old and young mdx mice respectively. Start position of the mice can also be varied; with either two or four limbs.
- the mouse handled by the tail, is allowed to grasp the middle of the wire with its fore limbs and is gently lowered so that its hind paws will grasp the wire a few cm apart from the fore paws.
- the mouse is then gently accompanied while it turns upside-down along the axis of the wire.
- mice can also use a start position with the two fore limbs, as is used in the "falls and reaches" method.
- a clear distinction can be made between mice who manage to grasp the wire with their hind limbs and those who are incapable to do so.
- the mouse is given three trials per session, with 30-sec recovery period between trials.
- mice that reach this fixed maximum, independent on the trial number, are allowed to stop with the experiment, while others are directly retested for a maximum of three times. In this case the maximum hanging time is recorded. In experiments where all mice have to hang for three trials, either the maximum hanging time or the average hanging time of the three trials can be used as an outcome measure.
- This reflects the tension (impulse) that the animal develops for maintaining itself on the wire, against gravity for the longest period of time.
- a fixed limit i.e. 180 or 600 sec
- the Holding impulse cannot be used, since it remains unknown what the maximum hanging time of the mice would be when no fixed time limit was used. In case none of the mice managed to hang for the fixed hanging limit, using the Holding impulse is preferred.
- Posology Twice daily oral application of 25 mg, 50 mg or 150 mg nintedanib.
- FormulationA Formulation B Formulation C mg per mg per mg per mg per mg per
- Lactose monohydrate 50.0 mg 125.0 mg -
- the formulation may be administered in the form of granules in different amounts, e.g. containing 25 mg, 50 mg or 75 mg of nintedanib. Also, the granules can be compressed to form tablets; thus, tablets of different strengths, e.g. containing 25 mg, 50 mg or 75 mg of nintedanib, may be obtained.
- the oral powder may be administered in different amounts, e.g. containing 25 mg of nintedanib.
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Abstract
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JP2023526247A (en) * | 2020-05-13 | 2023-06-21 | エッジワイズ セラピューティクス, インコーポレイテッド | Pyridazinone compounds for the treatment of neuromuscular diseases |
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